Matthay K K, Reynolds C P
Br J Cancer. 2000 Nov;83(9):1121-3. doi: 10.1054/bjoc.2000.1430.
A variety of pre-clinical and clinical data point toward high drug levels of retinoids being required to achieve optimal efficacy against neuroblastoma. The results of the Kohler trial reported in this issue demonstrate that low-dose 13-cis-RA does not have clinical efficacy against neuroblastoma in a setting of minimal residual disease. A comparison of the Kohler trial with the US CCG trial provides clinical evidence that high-dose levels of retinoids are optimal for treating minimal residual disease in neuroblastoma. The comparison of high-dose and low-dose 13-cis-RA studies in neuroblastoma suggests the intriguing possibility that high dose, pulse schedules of other retinoids could be effective as therapeutic and chemopreventive agents in diseases where low-dose, chronic retinoid administration was not effective. Pre-clinical and perhaps clinical studies of the latter concept should be considered.
各种临床前和临床数据表明，需要高剂量的维甲酸才能对神经母细胞瘤达到最佳疗效。本期报道的科勒试验结果表明，低剂量13-顺式维甲酸在微小残留病情况下对神经母细胞瘤没有临床疗效。将科勒试验与美国儿童肿瘤协作组试验进行比较，提供了临床证据，即高剂量的维甲酸是治疗神经母细胞瘤微小残留病的最佳选择。对神经母细胞瘤中高剂量和低剂量13-顺式维甲酸研究的比较表明，存在一种有趣的可能性，即在低剂量、长期给予维甲酸无效的疾病中，高剂量、脉冲式给药的其他维甲酸可能作为治疗和化学预防药物有效。应该考虑对后一种概念进行临床前研究，或许也需要进行临床研究。
